Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mrs. Larisa Ann Gillern, PHYSICIANASSISTANT

Individual provider Surgical Physician Assistant · NPI 1639793557

Mrs. Larisa Ann Gillern, PHYSICIANASSISTANT is a Physician Assistant in Greenwich, Connecticut. Qualified in 2021, 5 years ago. Practices as a sole proprietor.

Years since qualifying
5
In the registry since
2020

Practice location Address checks out

5 Perryridge Rd
Greenwich, CT 06830-4608
Phone: (203) 863-3000
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X

Record details

NPI number1639793557
Entity typeIndividual (Type 1)
GenderFemale
Credentials PHYSICIANASSISTANT
Sole proprietorYes
NPI enumeratedJune 5, 2020
Last updated in NPPESOctober 14, 2025
Certification dateOctober 14, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Accepts Medicare assignment Not indicated
Practice locations2 on file with Medicare

Other providers in Greenwich